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ADHD Pill Faces High Hurdle in Europe as Stigma Persists

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Re: ADHD Pill Faces High Hurdle in Europe as Stigma Persists

#51

Post by bradleyjg »

bayesianhorse wrote: post #41
linuxhansl wrote: post #24

Good. Medicine in the form of antibiotics and inoculations against various dangerous diseases has brought us far, but it seems to be time to rethink some of the recent developments. Maybe we can stop growing a monoculture of humans where the slightest deviation from the norm must be treated with some kind of drug. I am from Europe (but live in the US) and I salute the folks there resisting this nonsense. (And for the…

Denying the existence of mental disorders is dangerous and harmful to those who indeed have these disorders. And they are disorders. The science on this is very strong. You see "clusters" of similar conditions in millions of human beings, where each of these clusters/diseases have similar problems, and they share potential remedies. The problems these disorders cause the individual are very real and unmistakeably neg…

> The science on this is very strong. You see "clusters" of similar conditions in millions of human beings, where each of these clusters/diseases have similar problems, and they share potential remedies.

Would that were true! In fact the science is not very strong at all. We have descriptive sets of symptoms and we have classes of drugs discovered serendipitously that seem to help some sufferers, but despite 30+ years of effort we have little more than post hoc justifications for mechanisms of action and underlying causes.

The chemical imbalance theory has very little evidence going for it besides circular reasoning.

We are at the point in the science of mental illness where we go and categorize things -- this animal has a spine, gives birth to live young, and is warm blooded -- okay put it in this order. We need a Darwin, or at least a Mendel.

Re: ADHD Pill Faces High Hurdle in Europe as Stigma Persists

#52

Post by Mqlpidrien »

coopaq wrote: post #9

Some of the signs for ADHD from wikipedia: "Become bored with a task after only a few minutes, unless doing something enjoyable" "Have trouble completing or turning in homework assignments" "Struggle to follow instructions" "Be very impatient" "Be constantly in motion" "Thinks constantly being told what to do by others for 18 years kinda sucks" http://en.wikipedia.org/wiki/Attention_deficit_hyperactivity...

If I read the description of the wikipedia article, I could easily think that I suffer from ADHD. To me it feels a little bit like asperger syndrome where you can pick and choose related syndrome and believe you might suffer from it when you are just a little bit asocial. To exaggerate, it is like reading an horoscope and thinking that, woah, it is exactly how you are or how this person is.

Obviously there are trained doctors and psychiatrist and whoever who can judge whether or not a kid suffer from adhd but it seems that it will be way more than 7% of kid that could get bored by tasks they are being test for and that is why adhd seen from outside the usa feels too often diagnosed.

Others have said how the drug would have helped themselves or is helping themselves but has it been shown that the drug would not help everyone who takes it to focus and perform better at test and studying or working. Since I live in the USA, I have asked the questions to college student and it seems a fairly common thing to take a pill before exam to get that extra edge for focus (granted you don't start cleaning your apartment and become very thorough while doing it).

Even if the drug could help some people, it is not unreasonable to consider whether introducing the drug to society has an overall benefit and not just a benefit to the company selling it. France has already a problem with to many prescriptions of anti depressor drugs so maybe it is not a good idea to jump on adhd pills.

Re: ADHD Pill Faces High Hurdle in Europe as Stigma Persists

#53

Post by lutusp »

bayesianhorse wrote: post #41
linuxhansl wrote: post #24

Good. Medicine in the form of antibiotics and inoculations against various dangerous diseases has brought us far, but it seems to be time to rethink some of the recent developments. Maybe we can stop growing a monoculture of humans where the slightest deviation from the norm must be treated with some kind of drug. I am from Europe (but live in the US) and I salute the folks there resisting this nonsense. (And for the…

Denying the existence of mental disorders is dangerous and harmful to those who indeed have these disorders. And they are disorders. The science on this is very strong. You see "clusters" of similar conditions in millions of human beings, where each of these clusters/diseases have similar problems, and they share potential remedies. The problems these disorders cause the individual are very real and unmistakeably neg…

> Denying the existence of mental disorders is dangerous and harmful to those who indeed have these disorders.

The people you're talking about aren't denying the existence of real disorders, they're denying the existence of phony disorders -- and there are plenty.

Asperger's, popular a few years ago, is now recognized as a myth and has been removed from the DSM. Until the mid-'70s homosexuality was listed among the phony mental illnesses, finally removed after much pressure was put on the practitioners of this pseudoscience.

> The science on this is very strong.

The science of this is practically nonexistent. Are you aware that the director of the NIMH, the highest-ranking psychiatrist in the country, has recently decided to pull the plug on the DSM, describing it as too unscientific to be useful? And that, by pulling the plug on psychiatry's "Bible", he pulled the plug on psychiatry's dubious standing as a science?

> The problems these disorders cause the individual are very real and unmistakeably negative.

No more real than the average placebo response, which as time passes is becoming the default assumption that must be taken into account and that cannot be categorically eliminated until science eventually enters the field.

There is a core of very serious cases, like schizophrenia and some bipolar sufferers, but those are not mental illnesses, they are physical ailments with psychological symptoms. Purely mental illnesses have no scientific explanation, no reliable diagnostic criteria, and no treatments -- which is why the DSM is being abandoned.

> Sometimes conspiracy nuts equate mental disorders with some kind of "dissident" behavior that has to be censors.

You mean, like the editor of DSM-IV, now a critic of the mental health field, who has just written a book arguing that the epidemic of overdiagnosis collides with natural diversity? Like that? Are you aware that nature thrives on a wide spectrum of behaviors, that such a spectrum represents the genesis of all future improvements in the species?

"Saving Normal" (Allen Frances): http://www.amazon.com/Saving-Normal-Out-Control-Medicalizati...

NIMH director Insel: http://www.nimh.nih.gov/about/director/2013/transforming-dia...

Quote: "While DSM has been described as a “Bible” for the field, it is, at best, a dictionary, creating a set of labels and defining each. The strength of each of the editions of DSM has been “reliability” – each edition has ensured that clinicians use the same terms in the same ways. The weakness is its lack of validity."

Couldn't have said it better myself.

Re: ADHD Pill Faces High Hurdle in Europe as Stigma Persists

#54

Post by linuxhansl »

linuxhansl wrote: post #24

Good. Medicine in the form of antibiotics and inoculations against various dangerous diseases has brought us far, but it seems to be time to rethink some of the recent developments. Maybe we can stop growing a monoculture of humans where the slightest deviation from the norm must be treated with some kind of drug. I am from Europe (but live in the US) and I salute the folks there resisting this nonsense. (And for the…

To many of the commenters, have a look at this: http://www.cdc.gov/ncbddd/adhd/data.html

This is from the CDC.

* 9.5 of all kids diagnosed with ADHD * 13.2% of boys * 22% increase of children with a parent-reported ADHD diagnosis between 2003 and 2007

Really? You think this is OK?

Re: ADHD Pill Faces High Hurdle in Europe as Stigma Persists

#55

Post by DannyBee »

saosebastiao wrote: post #29
DannyBee wrote: post #20

Given there are non-stimulant alternatives available at this point, one would hope they would be tried first with children. Among other things, Ritalin and friends used to completely suppress my appetite, which while it may sound cool, is really "not great".

I only know of one non-stimulant alternative (strattera), and it didn't work for me (it handled the ADHD to some degree, but the side-effects were terrible). They definitely could use a little more progress in that area, as I would love to stop using Amphetamine derivatives.

For children, there is Intuniv and Kapvay.

For adults, only straterra.

You do sometimes see wellbutrin as an off-label use.

I'm also curious which side-effect you experience from strattera. In my mid-20's, I moved off amphetamines onto it, and have had no side-effects at all.

There is essentially no progress in this area because nobody cares. They keep finding new amphetamine derivatives to make, and they are quite cheap to produce, and still patentable.

Re: ADHD Pill Faces High Hurdle in Europe as Stigma Persists

#56

Post by Bluestrike2 »

uniclaude wrote: post #50
anigbrowl wrote: post #39

Earlier quoted context omitted.

thanks to uninformed attitudes like yours, I was unable to get any treatment for my ADHD for years while living in Europe. Instead I was told that I was stressed because I was depressed, and depressed because I was stressed, and made to feel like it was my fault for not being easily treatable. Maybe we can stop growing a monoculture of humans where the slightest deviation from the norm must be treated with some kind…

What you should think about is that for one person like yours that stays untreated with your ADHD, in the US there might be a lot of kids forced to undergo treatments for what is no real ADHD. I grew up in Europe, and I seriously think that I would have spent my life under a very high amount of drugs if I had been raised in the US. I'm very glad I didn't have to go through this, because in Europe it is much more diff…

Of the two attitudes, only one ensures that those who do suffer from ADHD aren't able to receive treatment. Misdiagnosis, when it occurs, is able to be handled on a case-by-case basis; the "no such thing" stigmatization and other similar lines of reasoning, on the other hand, are a priori positions that reinforce biases that actively work against those who are seeking treatment and those who should but aren't, and as a result, directly contributes to underdiagnosis.

No one looks at increases in cancer rates and decries them as an rising tide of overdiagnoses. Only when talking about mental health can people get away with this sort of shoddy reasoning. A few points:

First, the argument itself is faulty. By their very nature, diagnosis rates aren't able to support conclusions in either direction on the matter. An increase in diagnoses is not the same as an increase in misdiagnoses. There are multiple significant factors that can contribute to an increase in diagnoses over time (i.e. heightened awareness, decreased in stigma that would otherwise have prevented the patient from seeking treatment, better diagnostic tools, properly recognizing edge cases where ADHD was previously misdiagnosed, etc.). We've seen similar things with other illnesses as well.

Simply put, the question that you're trying to raise (but aren't) is more nuanced: what percentage of those diagnosed do not meet the diagnostic criteria? The two questions are quite distinct.

Second, we're not exactly working from a comparable baseline when we look towards previous years. Consider factors such as a broader recognition of ADHD symptoms, openness to not simply writing those same symptoms off as "that's the way the world works" or "kids will will be kids", and relative decreases in stigmatization of ADHD itself (e.g. "ok, this is different from those really bad disorders like... schizophrenia [gasp]"). Net result, increased visibility which damn well ought to lead to increases in overall numbers just as it would for any diagnosis, psychological or otherwise.

Third, there isn't much scientific evidence to support the idea that ADHD is overdiagnosed. Even in cases where patients don't meet the diagnostic criteria, there's a growing body of evidence that they nevertheless exhibit more symptoms than average. So even in those cases, they're quite different than your idealized vision of regular kids being fed a daily diet of all the psychopharmaceuticals they can swallow. If you're interested, here are a few articles you can start off from:

- http://www.cdc.gov/ncbddd/adhd/play2.html

- http://www.psychiatrictimes.com/adhd/problems-overdiagnosis-...

- http://jad.sagepub.com/content/11/2/106.abstract

- http://www.ncbi.nlm.nih.gov/pubmed/22956714

Anyhow, mental illness--regrettably--has a nasty assortment of baggage. For centuries the mentally ill were criminalized, marginalized, and locked away. Crazy or not crazy. And though we've moved away from a great deal of the worst of these excesses, many of them are still with us. Maybe one day we'll get our heads out of our collective asses.

Re: ADHD Pill Faces High Hurdle in Europe as Stigma Persists

#57

Post by bayesianhorse »

bradleyjg wrote: post #51
bayesianhorse wrote: post #41

Earlier quoted context omitted.

Denying the existence of mental disorders is dangerous and harmful to those who indeed have these disorders. And they are disorders. The science on this is very strong. You see "clusters" of similar conditions in millions of human beings, where each of these clusters/diseases have similar problems, and they share potential remedies. The problems these disorders cause the individual are very real and unmistakeably neg…

> The science on this is very strong. You see "clusters" of similar conditions in millions of human beings, where each of these clusters/diseases have similar problems, and they share potential remedies. Would that were true! In fact the science is not very strong at all. We have descriptive sets of symptoms and we have classes of drugs discovered serendipitously that seem to help some sufferers, but despite 30+ year…

Depression for example is a very real problem for those affected. Several drugs are available which provide repeatable relief. Countless studies show, that suicide can be prevented through anti-depressants which mostly don't cause major side effects, leaving the patient much better off.

A lack of understanding why these drugs work does not mean that the diseases they are often successfully treating is "phony".

Re: ADHD Pill Faces High Hurdle in Europe as Stigma Persists

#58

Post by bayesianhorse »

derefr wrote: post #16
chimeracoder wrote: post #14

Earlier quoted context omitted.

> There's no simple physical process you can put prodrugs through to turn them into something that will get you high; The fact that Vyvanse is a prodrug is emphasized heavily in its marketing, but the anti-abuse potential is overstated, IMHO. Even some very cursory searching on Bluelight, et. al. will yield a dozen ways to either magnify or dampen the effects of Vyvanse using common foods, etc. > with Adderall/Ritali…

> Well, we can't prescribe any psychiatric medication, addictive or not, to people who are "self-diagnosed". I meant "self-diagnosed" as in "books an appointment with a therapist because they think they have X, whereupon the therapist tests them for X, and then sends them to a psychiatrist who tests them more carefully for X and, finding that they do have X, prescribes them medication for X." Junkies can and do game…

How exactly is it supposed to work then? People don't recognize the symptoms of mental disorders in themselves or others. Sure, you can tell if someone is having an extreme psychotic episode, or an extreme depression. In less extreme cases outwardly "harmless" symptoms of depression or ADHD are wrecking people's lives.

The potential abuse of the system does not mean it doesn't do more good than harm.

Re: ADHD Pill Faces High Hurdle in Europe as Stigma Persists

#59

Post by Marwy »

lutusp wrote: post #53
bayesianhorse wrote: post #41

Earlier quoted context omitted.

Denying the existence of mental disorders is dangerous and harmful to those who indeed have these disorders. And they are disorders. The science on this is very strong. You see "clusters" of similar conditions in millions of human beings, where each of these clusters/diseases have similar problems, and they share potential remedies. The problems these disorders cause the individual are very real and unmistakeably neg…

> Denying the existence of mental disorders is dangerous and harmful to those who indeed have these disorders. The people you're talking about aren't denying the existence of real disorders, they're denying the existence of phony disorders -- and there are plenty. Asperger's, popular a few years ago, is now recognized as a myth and has been removed from the DSM. Until the mid-'70s homosexuality was listed among the p…

>There is a core of very serious cases, like schizophrenia and some bipolar sufferers, but those are not mental illnesses, they are physical ailments with psychological symptoms. Purely mental illnesses have no scientific explanation, no reliable diagnostic criteria, and no treatments -- which is why the DSM is being abandoned.

What about depression? OCD? Anxieties? Are they "physical ailments with psychological symptoms"?

Re: ADHD Pill Faces High Hurdle in Europe as Stigma Persists

#60

Post by bayesianhorse »

code_duck wrote: post #4
jasonlotito wrote: post #3

Earlier quoted context omitted.

Of note: Adderall is by far not the only drug available for ADHD, and considering its addictive nature, should not be the first on you try.

What could be wrong with dosing children with amphetamines every day for years?

If you are not treating a child with severe or even moderate ADHD with Amphetamines, the risks are severe and not so rare at all.

Almost by guarantee the child will not achieve remotely as well as it could. Both in school and within social groups. Both of these failures will almost by guarantee lead to further problems down the road.

It has been shown that untreated ADHD multiplies the risk for other very real disorders, like bipolar disorder for example.

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